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Medicaid Eligibility Manual

MEPL 53 (Medicaid: 2011 Federal Poverty Level Income Guidelines for Medicaid Programs)

Medicaid Eligibility Procedure Letter No. 53

February 1, 2011

Effective Date:       January 1, 2011

OAC Rule:    5101:1-39-01.1, 5101:1-39-01.2, 5101:1-40-26, 5101:1-41-30

To:               All Medicaid Eligibility Manual Holders

From:           Michael B. Colbert, Interim Director

Subject:        Medicaid: 2011 Federal Poverty Level Income Guidelines for Medicaid Programs

Reason for Change:         On January 20, 2011, the United States Department of Health and Human Services updated the federal poverty level (FPL) income guidelines.

New Policy:  The FPL income guidelines for Medicaid programs have changed effective January 1, 2011.

Action Required:    Beginning January 1, 2011, the CDJFS must determine initial and ongoing eligibility for Medicaid using the following FPL income guidelines:

2011 Monthly Federal Poverty Level Income Guidelines

Family

Size

Healthy Families

90%

Healthy Start

150%

Transitional

185%

Pregnant Women

& Healthy Start

200%*

1

$817

$1,362

$1,679

$1,815

2

$1,104

$1,839

$2,268

$2,452

3

$1,390

$2,317

$2,857

$3,089

4

$1,677

$2,794

$3,446

$3,725

5

$1,963

$3,272

$4,035

$4,362

6

$2,250

$3,749

$4,624

$4,999

*This standard is used for children when no creditable insurance exists.

MBIWD 2011 Monthly FPL Income Guidelines

Individual Income Guideline 250%

$2,269

 


2011 Monthly FPL Income Guidelines for Premium Calculation

Family Size

MBIWD 150%

MBIWD 450%

1

$1,362

$4,084

2

$1,839

$5,517

3

$2,317

$6,949

4

$2,794

$8,382

5

$3,272

$9,814

6

$3,749

$11,247

 

2011 Medicare Premium Assistance Program

FPL Guidelines*

Single

Couple

Qualified Medicare Beneficiary (QMB) 100% FPL

$908

$1,226

Specified Low Income Medicare Beneficiary (SLMB) 120% FPL

$1,089

$1,471

Qualified Individuals-1 (QI-1) 135% FPL

$1,226

$1,655

Qualified Working Disabled Individual (QWDI) 200% FPL

$1,815

$2,452

*Because there was no cost-of-living adjustment increase for individuals receiving Social Security benefits (i.e., no adverse action period), the effective date of this change is effective January 1, 2011.

A mass change will not be run for any individuals affected by the federal poverty level increase. However, for any cases identified as denied or terminated using the previous year's FPL income guidelines, counties must redetermine eligibility using the FPL income guidelines contained in CRISE tables THST and TMEP.

For individuals who are already approved for MBIWD, the CDJFS is required to rerun the budgets, which includes redetermining the premium. When the CDJFS has determined the updated premium is lower, the CDJFS must reduce the individual's premium obligation. However, the CDJFS shall not increase the premium of any MBIWD individual until the annual redetermination.

In order to identify denied cases for January 2011, CDJFS staff will need to have access to the Business Intelligence Channel (BIC), found on the ODJFS innerweb at http://innerweb.odjfs.state.oh.us/omis/biss/bic/index.shtml. Instructions for accessing BIC will be found there.

Two desk aids, called "CFC/MPAP FPL BIC Report Instructions" and "MBIWD FPL BIC Report Instructions", are available in the Medicaid Eligibility Manual (MEM) describing how to generate CFC/MPAP and MBIWD medical assistance closure reports using the BIC. The data needed to generate this report should be available in BIC beginning on February 14, 2011.To determine whether eligibility needs to be determined in a case listed on this report:

1.       Verify why the case was listed on the report by looking at AEWAA history screens for the authorization date and reason codes. If the case was denied or terminated due to income, go on to step 2.

2.       Review IQCT - If AEORE or AEABC was last run on or before January 20, 2011, re-run the case to redetermine eligibility.

A CRIS-E View Flash Bulletin (CLVB) is issued with the information contained in this MEPL. The current income standards can be found in CRIS-E reference tables THST and TMEP.

MEM Instructions:

Location

Remove

Replace

MEPLs

MEPL 31 (Effective January 1, 2009)

MEPL 53

(Effective January 1, 2011)

MEPL 32 (Effective January 1, 2009)

MEPL 33 (Effective January 1, 2009)

Medicaid Eligibility Policy Letter Nos. 31, 32, 33 are obsolete upon the effective date of this MEPL.

This MEPL is also available on the Internet and may be accessed at:

ODJFS Electronic Manuals:

http://emanuals.odjfs.state.oh.us/emanuals

InnerWeb Calendar:

http://www.odjfs.state.oh.us/lpc/calendar/staff/

Internet Calendar:

http://www.odjfs.state.oh.us/lpc/calendar/

Business Intelligence Channel:

http://innerweb.odjfs.state.oh.us/omis/biss/bic/index.shtml

 

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